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Laparoscopic Iliopubic Tract Repair with Transabdominal Preperitoneal Hernioplasty after Radical Prostatectomy
Sung Ryul Lee1, Geon Young Byun1
1Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea.
Background And Objectives:
In patients with inguinal hernias who have undergone radical prostatectomy, dissecting the medial preperitoneal space is difficult because of the presence of fibrotic scars. It is also difficult to guarantee sufficient space for mesh implantation. We added laparoscopic iliopubic tract repair (IPTR) to transabdominal preperitoneal (TAPP) hernioplasty, and evaluated this for the treatment of inguinal hernias after radical prostatectomy.
Methods:
This retrospective study included 29 male patients with inguinal hernias after radical prostatectomy who underwent TAPP hernioplasty between January 1, 2015 and October 31, 2018. Laparoscopic IPTR was performed first, followed by TAPP hernioplasty.
Results:
All patients had an indirect inguinal hernia. The mean time from radical prostatectomy to TAPP hernioplasty was 2.1 years (range, 0.3-11 years). In one patient, the peritoneal flap was insufficient, and the operation was performed using a dual-layer mesh. All other patients underwent conventional TAPP hernioplasty. The mean operation time was 42 min (range, 30-50 min), and the mean duration until return to normal activities was 8.4 days. There were two minor postoperative complications (one hematoma and one seroma). The mean follow-up period was 45.8 ± 14.0 months (range, 22-67 months), and chronic pain or recurrence was not observed.
Conclusion:
Adding laparoscopic IPTR to TAPP hernioplasty in patients with a history of radical prostatectomy is feasible and safe, with a low risk of chronic pain and recurrence.
Insights
Adding laparoscopic iliopubic tract repair to transabdominal preperitoneal hernioplasty is a safe and effective treatment for inguinal hernias in patients who have had a radical prostatectomy, with low recurrence rates.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Radical prostatectomy can lead to scar tissue, complicating inguinal hernia repair.
- Sufficient space for mesh implantation is often challenging in these cases.
Observation:
- A retrospective study evaluated 29 male patients with inguinal hernias post-prostatectomy.
- Laparoscopic iliopubic tract repair (IPTR) was performed before transabdominal preperitoneal (TAPP) hernioplasty.
- The mean follow-up was 45.8 months, with no observed chronic pain or recurrence.
Findings:
- The combined IPTR and TAPP procedure was feasible and safe.
- Mean operation time was 42 minutes, with a mean return to normal activities of 8.4 days.
- Only minor postoperative complications (hematoma, seroma) were reported in two patients.
Implications:
- This combined laparoscopic approach offers a viable solution for complex inguinal hernias after prostatectomy.
- It demonstrates a low risk of chronic pain and recurrence, improving patient outcomes.
- Further research can explore long-term efficacy and patient selection criteria for this technique.
